Bill Osborne

" or Stat Use Only Goad) STATE ETHICS COMMISSION Ore Resets Ars) Sl Ji 2022 STATEMENT OF ECONOMIC INTEREST RECEIVED FEB 82 2622 This entire form must be completed to fulfill _— your ethics filing obligation. NCETHICS COMMIS J iddis Name Cestvame =] 4 Kyle Fibone Job Tite [Slt Foplyel | dune Nature or Type of Businéés - — form! State Government 105 (Speci agency and postion.) Board/Commisson (List the complete names of al State | boards on which you are serving or re being considered.) Higls Loveitr Lig TA Currently Serving a5 a Judical Officer (Specly office) | Corry Serving as a Uaislato (Specty House or Senate.) “Are you a CANDIDATE for a covered elected office? | [If Ves, Speciy Office an Distrit/County, f applicable: (District or Superior Court, Court of Appeals, Supreme Court, Clrk of Cour, District Attorney, o Legislator) Oves Ono 3 ‘A. Do other immediate family members reside in your household? Hes Oo On this form, “immediate fami” includes your spouse (unless legally separated). It alo Includes members of your extended family (your and your spouse's children, orandehiaren, parents, Srandparents, and siblings, and the spouses of ach of those persons) who reside In your household. List the full name of all adults and emancipated minors in your household. Minors are children under 18. They are emancipated by marrage, enlistment in the US milkary, or court order for emancipation “Full names of Adults and | _ Relationship Employer | Job Titie Nature of Business. Emancipated inors The SEX and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 Initials of Employer Job Title ‘Unemancipated [pone | | 1] p— EYes [ONo [owner of Real Estate| % Ownership Interest Location by City Location by County OYes [Ml FT TTT ET — po i Oves fo amore | emewrmme | wectresey Qves Hf [ ownerofmmeres | Full Name of Company or ticker symbol ee OYes Eto [ClYes [No - If "No," proceed to question 4. [ ouncrofmmees | Name of Company or Business Entity C2). I you know tha any enty sted In 5.C or 3.C(1) above has ary material business Gesings o business contracts wih the State of North Coral, or regulated by the Se, bi descoe tha Duane Ay. Name of Company or Business Entity Description of Business Activity with the State oe or ot Known 4. As of December 31, 2021, were you or any members of your Immediate fom th beneficiaries of 3 vested tut Wi vale of $10,000 or more nat you rest, establoned o controled? > 00 nt Ist assets held n bind trusts, Definitions or "Vested Trust” and “Bind Trust” can be found an our website inderSEls | SEL Haptol Tos" its ethic. gov Ove rf Nome and Address of Trustee Description of the Trust Your Relationship tothe Trust 5. As of December 31,2021, 0d you any members of your Imadate fri hove bilies of $10,000 or mar, excluding he mertzage on your pH personal resience? Examples incu 160k ard Gabe, outs loon, Soden oon, persona ans, and nc amy Geb Ove fe Name of Debtor Type of Creditor (commercial Bank, credit union, individu atc) 6. List each source of income (mot specific amounts) of more than $5,000 received by you or any members of your immediate family during 2021 Include Saar, wa0e, Sae/0cs Joana ELE orm, efecsanss foe Honora, Interest, didence, ental Income, BUSES Income, and other Bs reared 0 be esas on Ge ond federal ok returns. + Attention! You must disclose salary or wages received from any governmental or private ently, including employers that you may have already listed in response to other SEI questions. + Do nat include income received from the folowing sources: Caplal Gans; federal government or miltary element benef; socal seuty/ 501 Recipient of Income Nama of Source Tym ol Type of Tncome Bltiness/ Industry 31 had no reportable Income aver £5,000 fn 2021. Poon [tend gent | TT] The SET and any attachments, excluding the Confidential Form, are public records. Page sof 10 Professional and Civic Relationships 702). During 2021, were you or ony members of your immediate fay decor, officer, governing boord member, employee, Independent contractor, of registered labbyit of 3 nonprofit comaraion or crgaizaon operating In North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? OYes flo -16 "No," proceed to question s. > 00 not Ia Sate bords or entities. » 00 not Ist organizations of which you ae a mere member. Position Name of Nonprofit Nature or Corporation or Organization | Purpose of Organization 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive Sete funds, ey Gea the rvurs of ha busines, know o with Gigence coud reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business Citone or a Known a During 2021, were you o any member of your mediate fay » decor, offer, o Governing boad amber of any Society organaton, of Avecacy au with an terest In makers ovr whh You agency o board ay hove Sunadiiont [Ives [26 ClLegisator/udicl Officer - You ae not required to complete this question you are fing solely Setause you ar a egltor or adil aficer or 2 8 candida o appontee ta those aces, However, you ars. 150 i 35.8 member of a Sat board or 5 8 tats employes, pense answer “yes” or “no” to this question. If your response is “yes,” provide additional information. » Do nots rganizatons of which you are nly a member and do ot serve na ladersip rl. Name of Society, Organization, Leadership Position or Advocacy Group (irector, Officer, Board Member) The SEX and any attachments, excluding the Confidential Form, are public records. Page sor 0 was an employee, director, oficer, partner, proprietor, ar member or anager 5 of December 31, 2021. [ameter | sotensiptorier | mesicompeny | saestrern | I EE EE EE EE EE EE rT rr rT — 506). 1 you know that any entity sted in 52) above had any material business dealings or business contracts with the State of North Carolina or as regulated by the State as of December 31, 021, rey descrios tak act. rr 7] rr EE 1 10. Ave you practicing atarney? Oves [fo [Judicial Oficer/State Attorney. 1°Yes', check each category of legal representation in which you orth lw im with which yau are ffated hos camed Iegl fe of more han $10,000 daring 2021 Cladmimistrative Cadmiraty OCorporte Oicaminal DOioecedents Estates Environmental Citnsurance DOltabor toca Government Rest property Osecurtes Om [Tort litigation (including (0 utilities Regulation (J Other category not listed negligence) 11. During 2021, were you licensed professional (other than an storey) or id you provide consulting services Individual or a5 3 member of a profesional assoc ation or whe You ChaTed o wre pod over $10,000 I YT rr rr I The SEX and any attachments, excluding the Confidential Form, are public records. Pages of 10 12. Are you o your employer, o any members of your immediate family, or their employers curently: + licensed by the State board or agency with wich you are o willbe assodated or + regulated by the State board or agency with which you sre or vil be associated or + ina business relationship with the State board o agency with which you ae or wil be associated? OYes fo [JLegisator/uical Office - You are not required to complete this question f you are fling because: you are a legislator or judicial officer or 24 a candidate or appointee to those offices. However, If you are also filing 2s 2 member of a State board or as a State employee, please answer “yes” orn to ths question. 1 you respond “yes, provide addtional information. Name of Employer Type of Relationship (it applicable) (Licensing, Regulatory, Business) 13. Have you or a member of your Immediate family been registered 2s a Iobbyst o lobbyist principal within the 12 months preceding your fling of this form? Oves &fo Name of Lobbyist Lobbyists principal Date of Registration Registration Expiration Other Disclosures 14. During 2021, afer you were appointed, employed, or fled or were nominated 20 candidat, dd you + receive any “git(s)" exceeding $200 per quarter from a prsan or group of persons acting together, + when both you and those person(s) were outside North Carolina, + under circumstances that would lead reasonable person to conclude the gifs were given for lobbying? To answer Yes, ll tree conditions must apply. Oves fo » Do not report git given by members of your extended foi. > Do not report gifts you have previously reported an the “Expense Report for Exempted Persons.” ‘Date Ttem Received | Name and Address of Donor(s) | Describe Item Received | Estimated Market Value The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 Ey including tuition, travel, lodging, meals, and other similar expenses. A OYes lo [&Fo contribution(s) with a cumulative total of more than $1,000 7 re you an appantes o respecte appotes 35 a. the head of a principal state department (e.g., cabinet secretary) appointed by Te Covaner or b. 2 rth Coron Supreme Court uate or a Court of Appeal, Super, or Dt Cou ero <a member of any of the folowing boards: Oves ero 27 hac Commission Nor proceed 0 question 1. _ Consol Resources Commission © Stte Bowrao Education © State Board of lcions * owion of Employment Securty © Environmental Management Commission © industrial Commission Human Resources Commision + Rules Review Commission | © oard of Tansprttion | Uttes Commision | © Wide Resources Commission d. 1f so, were you appointed or are you being considered for appointment to that | [1 Yes []No 1 Soin ys Come of Se member? scuttle £ I so, you must le haves during 2021 you engaged i ary of iit Scies win espa oo or pha of the canats oF pm | Coes of th Counc of ats mara who apps ou; | i Collected contributions from multiple contributors, took possession of such | Clie, onions, and Gansered or doersd hose coeced | CYes CINo omition 0 the cada or sommes? . I Hosted a fundraiser ot your eden o place of buses? [ove om | i Voloeeed fo campagne acti, ncuding phone are event em mle casing, von of a oer Say that Covance ine compa of a canes? To ave you ovr been comictad of 3 felony for whch you hve nak recavd ath: 0 2 pardon o (1) a order of ——p—— Ove @o [ omeme | oateot Conviction | County of Conviction | state of Conviction 5 ree you ware ofan oe formation at you bale ay S555 the ECs Commis avin you ening vou comptance wih he rts Governma, ones Act Oves Po 1fyes, please provide that information below. The SEX and any attachments, sxcluding the Confidential Form, are public record. Page 9ot 10 ‘The information provided in ths Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and belief 1 have not transferred, and will not transfer, any asset, Interest, or property for the purpose of concealing It from disclosure while retaining an equitable Interest 1 understand that my Statement of Economic Interest and any attachments except for the Confidential Form regarding Unemancipated Children are publi records. 1 have read and understand the following statutes: N.C.G.S. § 1384-26. Concealing or failing to disclose material information. A fling person who knowingly conceals or knowingly fais to disclose information that s required to be disclosed on a statement of economic interest .... shall be guity o a Class 1 misdemeanor and subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 1384-27. Penalty for false Information. A filing person who provides fase information on a statement of economic Interest . . . knowing that the information Is false Is guity of a Class H felony and shell be subject to disciplinary action under G.S. 1384-45. Taffirm under penalty of perjury that the foregoing is true and correct. a yr. Bil Osborn Frinted Name ‘Submit signed, original documents only. Do not fax or e-mall this form. | The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 10